MEDICARE: BONNIE LOUISE KELL LCSW, LCAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	22495	NC
3	1041C0700X	Clinical Social Worker	C011781	NC
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1245771914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE LOUISE KELL LCSW, LCAS

Provider Business Mailing Address
First Line	:	200 HIGHWAY 54 BYP APT N102
Second Line	:
City	:	CARRBORO
State	:	NC
Zip	:	27510-1594
Country	:	US
Telephone Number	:	919-428-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 E FRANKLIN ST
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27514-2812
Country	:	US
Telephone Number	:	919-428-3111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2017
Last Update Date	:	04/27/2023

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